Abstract 3502: Serum Phosphorus Levels are Associated with Incident Fatal and Non-Fatal Coronary Disease in Men but not in Women in the Community
Mineral metabolism disorders are associated with coronary atherosclerosis and poor outcomes in chronic kidney disease (CKD) and cardiovascular disease (CVD) patients. A recent study suggested that elevated levels of serum phosphorus are associated with increased risk of CVD in subjects free from CKD and CVD. However, data suggest that the distribution of serum phosphorus differs by gender and it is not known whether phosphorus carries the same prognostic significance in men and in women. We tested the association of baseline serum phosphorus levels with incidence of CHD (myocardial infarction or fatal coronary disease) in 13,998 subjects 45 to 64 years old free of CHD, stroke, or CKD from the Atherosclerosis Risk in Communities (ARIC) study with public use data. The mean follow up was 12.5 years. Serum phosphorus was classified according to quintiles. Elevated phosphorus was significantly associated with age, female gender, smoking, hypercholesterolemia, and fibrinogen levels (p < 0.0001 for each), but was inversely associated with hypertension and not associated with estimated glomerular filtration rate (eGFR). We observed a j-shaped relationship of serum phosphorus with CHD among men but not among women. Compared to men in the 2nd quintile, men in the 1st quintile experienced a 30% increased rate of CHD (multivariable adj. HR: 1.30, 95% CI: 1.01, 1.68) while HRs increased incrementally from 1.17 (95% CI: 0.89, 1.54) to 1.51 (95% CI: 1.09, 2.09) from the 3rd through 5th quintiles. This relationship in men remained significant after adjustment for classic CVD risk factors and estimated GFR (table⇓). Among women, serum phosphorus was not significantly associated with CHD (table⇓). In conclusion, this study suggests a j-shaped association of serum phosphorus with CHD risk in men but not women free of CKD and CHD at baseline.